Current status of early diagnosis of developmental dysplasia of the hip more than 10 years after program implementation: a multicenter study of cases diagnosed in 2023 - 14/03/26
, Bernard Fraisse b, Manon Bachy-Razzouk c, Yan Lefevre d, Sebastien Pesenti athe French Society of Paediatric Orthopaedic (SoFOP) 1
Abstract |
Background |
Early diagnosis and appropriate outpatient management of developmental dysplasia of the hip (DDH) are crucial to reduce the need for surgical intervention and long-term complications. A nationwide screening program combining systematic clinical examination and selective imaging has been implemented in France since 2015. This study aims to assess the program’s efficacy in reducing hospitalizations and late-diagnosed cases of DDH.
Hypothesis |
We hypothesized that the national screening program has been effective in promoting early ambulatory treatment and reducing the rate of late DDH diagnoses.
Patients and methods |
A retrospective, multicenter study was conducted across 20 pediatric orthopedic centers affiliated with the French Society of Pediatric Orthopaedics. All patients hospitalized for DDH in 2023 were included, regardless of treatment modality. Demographic characteristics, risk factors, participation in the screening program, use of hip ultrasonography, and age at diagnosis were recorded. National hospitalization data were obtained from the Medical Information Department.
Results |
A total of 147 patients (22 boys, 125 girls) were included, representing 30% of national DDH hospitalizations in 2023. Mean age at diagnosis was 8.7 months (±12.3), with 87 (59%) diagnosed before 6 months and 47 (32%) after 12 months. Hip ultrasonography was performed in 81 patients (55%); among those, 67 were diagnosed before 12 months. In contrast, only 29 patients (49%) without ultrasound were diagnosed within the first year (p < 0.001). Notably, 35 patients (74%) diagnosed after 12 months had no identifiable risk factor. Considering female sex as a risk factor could have anticipated 39% of these late diagnoses. Despite a reduction in the overall number of hospitalizations since 2015, the incidence of late diagnoses remained stable at approximately 3 per 100,000.
Discussion |
The French nationwide screening program has significantly improved early diagnosis and facilitated outpatient treatment of DDH, contributing to a reduction in hospital admissions. However, its effectiveness remains limited for late-presenting cases, most of whom lack recognized risk factors. Including female sex as an additional risk criterion may enhance the program’s sensitivity and further reduce the rate of late diagnoses.
Level of Evidence |
IV; Retrospective multicenter cohort study
Le texte complet de cet article est disponible en PDF.Keywords : Congenital Dislocation of the Hip, Pavlik harness, Hip spica casting, Ortolani and Barlow maneuvers, Hip Ultrasound, Screening strategies
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